Agonizing decisions being made in Spain’s hot spots
ZARZA DE TAJO, SPAIN » Raquel Fernández watched as cemetery workers lowered her grandmother’s casket into the grave and placed it on top of the coffin of her grandfather, buried just three days earlier.
Eusebio Fernández and Rosalía Mascaraque, both 86, are two of Spain’s more than 10,000 fatalities from the coronavirus pandemic.
Like thousands of other elderly victims in Spain, their deaths this week illustrate one of the darkest realities of the crisis: Doctors at overburdened hospitals in need of more resources are having to make increasingly tough decisions on who gets the best care, and age appears to matter more than ever.
“Due to a lack of resources in this country, they won’t put an 86-yearold person on an assisted breathing machine. It’s simply that cruel,” said Fernández, a nurse. “My grandparents fought all their lives to be happy and build their strength so they could grow old with dignity, so of course this moment is very painful, and it is difficult for us to cope with.”
Her grandparents fell ill with a fever and cough. After staying home for several days as health authorities recommended, their son rushed them to a hospital in Torrejón, east of Madrid, on March 25.
Two days later, Eusebio died of respiratory failure after testing positive for coronavirus. Rosalía died 48 hours later but her test was inconclusive. Neither was put in an intensive care unit or on a ventilator, Fernández said.
She said her grandmother had a heart condition, but that she believed her grandfather was in excellent health and should have been given more of a fighting chance.
“I understand that between someone who is 30 or 40 years old and my grandfather, they will not choose my grandfather, but if this had happened in another moment, in a health care system that claims to be among the best in the world, this would not have happened,” she said.
Spain has recorded 110,238 infections, placing it just behind Italy’s 115,242 cases, which is the most in Europe. The Spanish government said Thursday the country had over 6,000 patients in intensive care. medical associations in response to COVID-19 also say age alone shouldn’t be a deciding factor. Among the situations where they said intensive care should not be provided if availability is in short supply: if the patient needs permanent intensive care to survive.
Experts also say hospitals must calculate how long a patient might need a hospital bed or ventilator and how many more lives the machine might otherwise save.
In hard-hit areas of France and Spain, patients “are hospitalized only when there is a chance to save them,” said Marc Bourquin of the French Hospital Federation.
Spanish doctors and nurses say they do not dispute that they offer the best care possible to every patient, but they said lack of ventilators and ICU beds amid increased demand have forced them to raise the bar on whom gets what treatment.
Dr. Olga Mediano of Spain’s Society of Pulmonologists and Thoracic Surgeons said it is not just about saving the youngest.
“You always have to decide the ceiling of care for a patient. You don’t want to put him or her through a treatment if it won’t be good for them,” Mediano told AP. “You would never intubate a patient who is 95 years old. They wouldn’t be able to take it.”
She described the current situation as unique, “with extremely limited resources and a certain number of ventilators, and intensive care units that are overwhelmed. You have to prioritize and see which patients will most benefit from certain treatments.”
She said nearly every hospital in Spain is doing so, “and we are probably being more restrictive in giving access to the ICU than before because we lack beds.”